Femoral hernia

The muscle of your abdominal wall is normally strong enough to hold in your intestines and organs. A femoral hernia develops when fatty tissue or part of your intestine bulges through a weakness in the muscle of your abdominal wall, specifically in an area that lies just below and either side of your groin called the femoral canal. The femoral canal contains lymphatic vessels and a lymph node. The protruding lump caused by a femoral hernia can usually be pushed back quite easily.

Femoral hernias, also called femoroceles, are uncommon. One in 20 abdominal hernias is a femoral hernia. Both men and women can develop a femoral hernia but they’re more likely to occur in women, particularly older women, as women tend to have a wider pelvis and so a larger femoral canal. A femoral hernia rarely happens in children.

A femoral hernia is usually the result of straining, perhaps because of:

• Carrying, lifting or pushing heavy loads
• Constipation
• Coughing
• In men, it can be caused by an enlarged prostate making it difficult to urinate

Occasionally a femoral hernia can be present from birth (congenital) and only become noticeable or cause discomfort as you get older.

If a piece of intestine becomes trapped and the blood supply is cut off, it is said to be incarcerated or strangulated. This is a serious condition needing emergency surgery.

A femoral hernia will almost always be operated on and repaired without delay as there is a high risk of complications. 

The cause of most femoral hernias is not known. However, you may be born with weakened abdominal muscle around the femoral canal or it may weaken over time. Straining can cause weakness. Factors that contribute to straining include: 

• Being overweight
• Childbirth
• Difficulty urinating due to an enlarged prostate
• Heavy lifting
• Persistent constipation
• Persistent coughing

You may have no femoral hernia symptoms other than a small lump around your groin area, usually near to your groin skin crease or sometimes just below the crease at the top of your thigh. This lump may:

• Cause discomfort or pain that worsens when you lift heavy objects, stand up or otherwise strain yourself — if the lump is next to your hip bone you may also experience hip pain
• Disappear when you’re lying down or push the bulge in
• Only be noticeable when you cough or strain

If your hernia is strangulated, symptoms include:

• Lower abdominal pain
• Nausea and vomiting
• Sudden pain in your groin
• The lump becoming red or purple and tender

If you have any of these symptoms, even if there’s no bulge, you may have an incarcerated or strangulated femoral hernia and should seek medical attention immediately. 

A strangulated femoral hernia can cut off blood supply to your intestines or bowel. The tissue will start to die and will only survive up to eight to 12 hours. This is a life-threatening condition and a medical emergency because of the risk of developing a life-threatening infection.

Femoral hernias often become medical emergencies because the femoral canal is narrow and its entrance is rigid with little give. This makes femoral strangulation more likely. 

If you notice a lump in your groin area, see your GP as soon as possible.

Your GP will ask about your symptoms, your medical history, and physically examine your stomach and groin. They may gently touch the area where your lump is to determine if you have a femoral hernia. If you have a large femoral hernia, they will likely be able to feel it bulging. 

To confirm the diagnosis of a femoral hernia or another type of hernia, your GP may refer you to a consultant. Occasionally, your GP or consultant will arrange for further tests, such as an ultrasound scan, CT scan or MRI scan.

If you have a femoral hernia, your doctor will refer you to a surgeon for femoral hernia repair.

Surgical repair is the recommended treatment for all femoral hernias.

Femoral hernia repair involves pushing the fatty tissue or piece of intestine that created the hernia back into your abdomen. During femoral hernia repair, your surgeon may also strengthen the weak spot in your abdominal wall using special mesh.

Femoral hernia repair can be carried out using either open surgery or laparoscopic (keyhole) surgery. Open surgery involves making a larger cut and therefore has a longer recovery period. Keyhole surgery involves making three to four keyhole-sized cuts, which reduces blood loss, pain after surgery, scarring and the recovery period. Your surgeon will discuss which option would be best for you. Your surgeon will also discuss the complications of femoral hernia repair with you, including the small possibility that your femoral hernia will recur.

After surgery, you should be able to return home on the same day and return to work in six weeks.